At present, my doctor is trying cipro on me to try and reduce my recent spiked PSA down from 13 back to its usual 2.4. My MRI provided a PIRAD 2 score, with no lesions or Gleason 4 or 5 evident. My doctor said "we" may need to consider a prostate biopsy. So...a bit of research indicates they come in two distinct types:
1. Transrectal - the most common version, though prone to urinary infections, some very serious afterwards.
2. Transperineal - the least used, though best for finding difficult to find PCa, and virtually no infections afterwards.
From a little research, it appears the medical profession use the transrectal method 97% of the time. This means one to 25 biopsy needles will be inserted through the rectum wall into the prostate. The procedure usually takes 15-25 minutes. The biopsy if blind, meaning a 12-16 needle gun will punch holes through the rectum into the prostate. If the biopsy is guided via MRI or ultrasound, then a single needle, one at a time, is used. Usually, the guided method requires less needle samples because the lesion to test is seen.
This inevitably means faecal matter from the bowel is often inserted deep into the prostate. This in turn can lead to serious infections, including sepsis requiring a hospital stay, and can be life threatening. To reduce the chance of infections, patients are given some sort of course of antibiotic prior, during and after the biopsy. This often does not prevent infection.
Recent travel to certain areas of the world can increase the chance of you carrying resistant bacteria and the transperineal prostate biopsy may be recommended if you have a higher chance of carrying those bacteria (e.g. ESBL). Likewise, if you have been treated with the antibiotics ciprofloxacin or Norfloxacin in the prior 6 months, you may be at risk of carrying resistant bacteria and a transperineal biopsy may be safer for you.
If the Biopsy is carried out as a transperineal prostate biopsy, then usually 12 to 24 needles, one by one, will be passed through a special grid with 5mm spacing's through the perineal skin into the prostate. As this route avoids the bowel, no faecal matter is carried into the prostate and infections are rare. Antibiotics are given prior, during and afterwards to assist in reducing infections.
The transperineal prostate biopsy procedure usually requires a general anaesthetic, though a local can be used. The procedure usually takes approximately one hour and is usually carried out as a day surgery visit. The transperineal prostate biopsy is the gold standard of biopsy. It can reach areas of the prostate transrectal can't. With an MRI image, the special grid can be referenced on that image to target the biopsy, and reduce the number of needle samples required.
At the 2015 European Association of Urology 30th Annual Congress. Research data, conducted from 2010 and 2013 as a side study of the Global Prevalence of Infections in Urology study, involved 1214 patients from 136 countries in Africa, Asia, Europe, and South America was presented.
It was stated, "Infection rates after transrectal prostate biopsy are on the rise, and are "considerably higher" than they were a decade ago, a worldwide prevalence study suggests". Outcome data 2 weeks after biopsy were available for 876 patients. Of this cohort, 97% had undergone transrectal biopsy and 98% had received prophylactic antibiotics (82% with Fluoroquinolone-based agents...eg, cipro).
Of these patients, 50% developed symptomatic urinary tract infections, 3% developed febrile urinary tract infections, and 4% were hospitalized for these infections. One patient died as a result. This is really a terrible result for the patient. It means half of the group developed urinary tract infections.
One doctor said, "If their risk of infection or hospitalisation is higher than the chances of high-grade prostate cancer, I would recommend against prostate biopsy."
In summary, despite evidence that transperineal biopsies pose significantly less infection risk than the transrectal approach, this worldwide study shows that 97% of clinicians still use the transrectal route. Probably because no general anaesthetic required, is a quicker procedure, and maybe, more cynically, more monies can be made.
Looking on this forum, it is littered with people who became infected after a transrectal biopsy and required treatment, sometimes in hospital. Some of the people to this day, 2 or more years after their transrectal biopsy still have long term issues.
If it is decided I do require a biopsy to determine what is going on with my prostate, then I will use the transperineal version, which just happens to be the method provided by my urologist.
Geoff